Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of General Surgery, University of Toronto, Toronto, Ontario, Canada.
Cancer. 2015 Feb 15;121(4):589-97. doi: 10.1002/cncr.29099. Epub 2014 Oct 13.
An increased incidence of neuroendocrine tumors (NETs) has been reported worldwide, but the reasons underlying this rise have not been identified. By assessing patterns of metastatic presentation, this study sought to examine the epidemiologic characteristics of NETs and the contribution of early-stage detection to the rising incidence.
A population-based retrospective cohort study was conducted with prospectively maintained databases linked at the Institute for Clinical Evaluative Sciences. Adult patients with a NET diagnosis from 1994 to 2009 in Ontario, Canada were included. The main outcomes included the overall and site-specific incidence, proportion of metastatic disease, overall survival (OS), and recurrence-free survival (RFS).
Five thousand six hundred nineteen NET cases were identified. The incidence of NETs increased from 2.48 to 5.86 per 100,000 per year. Metastases were found in 20.8% at presentation and in another 38% after the initial diagnosis. The proportion of metastases at presentation decreased from 1994 to 2009 (from 29% to 13%). Therefore, although the incidence of all NETs increased, the overall incidence of metastases did not change (0.63-0.69 per 100,000 per year). The 10-year OS rate was 46.5%, and the RFS rate was 64.6%. In addition to the primary tumor site, independent predictors of worse OS included an advanced age (P < .0001), male sex (P < .0001), a low socioeconomic status (P < .0001), and rural living (P = 0.049).
The incidence of NETs has markedly increased over the course of 15 years. This is the first study to provide evidence suggesting that the increase in the incidence of NETs may be due to increased detection. In addition to tumor characteristics, low income and rural residency portend worse survival for patients with NETs.
世界各地都报告称神经内分泌肿瘤 (NET) 的发病率有所增加，但尚未确定导致这种增长的原因。本研究通过评估转移表现模式，旨在检查 NET 的流行病学特征以及早期检测对发病率上升的贡献。
这项基于人群的回顾性队列研究利用安大略省临床评估研究所前瞻性维护的数据库进行。纳入了 1994 年至 2009 年期间在加拿大安大略省确诊为 NET 的成年患者。主要结局包括总体和特定部位发病率、转移性疾病的比例、总生存率 (OS) 和无复发生存率 (RFS)。
共确定了 5619 例 NET 病例。NET 的发病率从每年每 100,000 人 2.48 例增加到 5.86 例。就诊时发现转移 20.8%，初次诊断后又发现转移 38%。就诊时转移的比例从 1994 年到 2009 年下降（从 29%降至 13%）。因此，尽管所有 NET 的发病率均增加，但总体转移发病率并未改变（每年每 100,000 人 0.63-0.69 例）。10 年 OS 率为 46.5%，RFS 率为 64.6%。除了原发肿瘤部位外，OS 较差的独立预测因素还包括年龄较大（P < 0.0001）、男性（P < 0.0001）、社会经济地位较低（P < 0.0001）和农村居住（P = 0.049）。
15 年来，NET 的发病率显著增加。这是第一项表明 NET 发病率的增加可能归因于检测增加的研究。除了肿瘤特征外，低收入和农村居住预示着 NET 患者的生存预后更差。
